How to Set Your Day Rate as a Locum Tenens Dermatologist
The most common question I get, after "agency or direct?", is some version of "What should I charge?" Nobody wants to answer it in public, and understandably so. Recruiters won't, because a vague number protects their margin. Other locum docs might tell you privately, but there is so much variability from place to place that it can be hard to gauge what’s actually applicable to your situation.
I'm not going to hand you a single number, because a number without a method is useless the moment a clinic pushes back. What I'll give you is the way I think about it, so you can ask for a rate you can actually defend in a negotiation.
First, a framing point I've made before: I think in hourly, not day rate. "Day rate" is the industry's default packaging, and it's fine for a quick quote, but a day is not a fixed unit. A day can be twenty patients or forty, an 8-hour clinic or a 10-hour one with a mountain of after-hours inbox work. When you quote a flat day rate, you're the one absorbing all the variance. So even when I state a day rate, I've calculated it backward from an hourly floor and a defined clinic length. Pin down the hours before you agree to the day.
Start with your floor, not the market
Your floor is the number below which the assignment isn't worth uprooting your life for.
If you also work a permanent or part-time W2, you already know your effective hourly there. Your locums floor should sit meaningfully above it, because locums has to compensate you for things you may directly or indirectly already get from a W2 gig: benefits, retirement match, half of the self-employment tax, malpractice tail, paid admin time, and not living out of a hotel. If your W2 nets you the equivalent of, say, $250/hour all-in, a 1099 locums rate at $250/hour is a pay cut once you price in what you're giving up. Know your floor before anyone quotes you anything, because the first number you hear will anchor you if you let it.
Figure out what you're worth to the clinic
A clinic is generally not paying you out of goodwill. They're paying you because an empty chair costs them more than you do.
Do the math from their side. A reasonably busy medical dermatologist generates a lot of revenue per day between office visits, biopsies, destructions, excisions, and path. You usually won't know a locum clinic’s exact payor mix or collection rate, and you don't need to. Try to get a sense of the order of magnitude of the clinic’s collections, perhaps from a current or former employee. If a clinic collects, conservatively, $4,000–$6,000 on a day you cover, and they're offering you a rate that's a small fraction of that, there is room. If a clinic is looking for a locums doc, remember what the alternative is for them: an empty schedule, rescheduled patients bleeding to competitors, and staff they're paying to sit idle. So it pays to know your worth.
The variables that should move your number up
This is why it’s difficult to tell you an exact number for an hourly locums rate, unfortunately. You need to adjust for:
Volume and pace. Ten-minute slots for a full day is a different job than fifteens with catch-up blocks. More volume = higher asking rate.
Scope. Peds, cosmetics, complex excisions, biologics management, supervising mid-levels — anything outside a straightforward medical-derm day is added value and added liability. Account for this.
Admin burden. A weeklong stint where you power through the inbox is one thing. A month of covering path, labs, and patient messages after clinic is unpaid labor unless you negotiate paid admin time or fold it into the rate.
Location and desirability. A hard-to-staff rural site with a three-month backlog gives you far more leverage than a clinic in a saturated, highly desirable location. Undesirable-to-fill means better pay for you.
Notice and duration. A last-minute gap they need filled Monday is worth more than a comfortably-scheduled month you booked well in advance.
What travel and expenses are (and aren't)
Your rate is for your clinical work. Flights, rental car, and lodging are reimbursements, not compensation, and should be handled separately and in writing. Same for state license fees and the DEA registration for that state if the assignment requires them. Keep the clinical rate clean and negotiate expenses as their own line.
A note on productivity-based offers
Some clinics will float RVU or collections-based pay instead of a flat rate. I've written before about why I tend not to favor these - as a locums derm, productivity pay punishes you for no-shows, a weak payor mix, and poor revenue-cycle management (none of which you control and most of which you can't even see before you start). If you're uprooting your life to keep their clinic running, you should be paid for your time. The onus is on them to fill the seats and collect. Set a rate for your day and let them own the revenue risk.
The bottom line
There's no published table because the real answer is "it depends," and the dependencies are exactly the things you have to nail down yourself: your floor, ideally a general idea of their collections, the volume, the scope, and how badly they need you. Do that homework and you'll walk into the conversation with a number you can hold. Skip it and you'll take whatever the first email offers, which is precisely what the person sending that email is counting on.
Nothing here is financial or legal advice — I'm a dermatologist, not an advisor. Run your specific numbers, and get any contract reviewed before you sign.
